Up Front by Emma Hart

My best friend is dying. We don't know when - it could be a few months, it could be a year, depending on what palliative treatments are offered, or appropriate. What I do know is this: it's only been 3 weeks since the diagnosis, and this could be a short road, or a long road, but either way, at some point along it I could sure do with someone professional to talk to. That won't be covered by insurance, and neither, in this case, should it be. But I'm willing to bet that it will help. Emma is right when she said on the other thread that people don't just seek counselling for depression. It could, in fact, be argued that if we had less of a stigma about talky therapy, and less expensive medical care, that we might be a healthier nation, more willing to examine our deepest fears, and insecurities, and find a salve for them, solutions, that work to make our lives better.

Will be keeping you in mind and hoping the PA community is of help to you Jackie.

money

It's worse than just penny pinching. It's stupid penny pinching. SSRIs are cheap, but the cost of treating side effects can be cripplingly expensive. However, the department managing the budget for the SSRIs is probably different from the department handling the costs of side effects. The "not my budget" syndrome is one problem here. But worse there is every chance that the costs of side effects won't be borne by the insurer since they may well be acute costs and borne instead by the taxpayer, a win for the insurer. That the patient may suffer appears to be irrelevent to the insurer. I suspect that was not the intent when medical insurance groups were initially established.

If that wasn't enough it isn't even good math. A person on SSRIs a good chance to be on them for life since the weaning off period is long and hard. Talking therapy may not be quick (years is usual) but the aim is to give the patient the skills and ability to no longer need therapy. It can actually cure, rather than merely treat the symptoms. It is not clear that under those conditions that the choice to favour drugs is correct even under the simplest calculation of cost.

But the killer is this - it's meant to be about the patient - what is best for the patient should be what is prescribed - not what is best for the accountant. The aim is to allow the patient to live as productive and worthwhile life as possible, that is the value equation in this. Not whether there is a bonus due to the fund manager who met his KPIs.

less of a stigma about talky therapy

and more respect for those who are good at it

In my utopia, there would be funding available to all New Zealander's eligible for health care, to spend on up to 12 sessions? per year of therapy, without question or need to justify. You could just have it. I suspect the long term economic and health savings would more than justify it, and for those who needed more, for whatever reason that could then be funded on a case by case basis. That would go a long way towards making it acceptable and reducing the stigma.

I totally agree Bart. And Increasingly I've been thinking this week, is health services and profit driven models just fundamentally incompatible? Is it even possible to do this ethically?

Hi Jackie, This isn't free but it is partially funded and they have a generous sliding scale based on means:
http://www.griefcentre.org.nz

What I do know is this: it’s only been 3 weeks since the diagnosis, and this could be a short road, or a long road, but either way, at some point along it I could sure do with someone professional to talk to. That won’t be covered by insurance, and neither, in this case, should it be. But I’m willing to bet that it will help. Emma i

V. sorry to hear this Jackie...I lost my best non-family friend on January 19th this year. She'd had a couple of run-ins with lymphoma before, but knew that was the end.

I am v. lucky: I have people who are trained to counsel the ill & bereaved in the family, and while I didnt need to ask for their help, they let me know talk-help was freely available...

I am even luckier: I have 2 beaches I love - and love walking - & good foodie friends & wine when wanted-

I miss Jude a lot (we were neighbours & friends for nearly 38 years) but -lives end. For me, when we die, that's it...and the best way I can honour my memories
of a person I love who has died, is to keep living the best way I can.

thanks for this, Kyle - bless you x

Absolutely! Carol's been in my life for 33 years, the problem is she's gone from being perfectly healthy one minute to having abdominal pains and then 5 weeks later, do not pass go, she's terminally ill. Beaches are good, dogs are good, people are good, but the gaping hole that will be left has to be addressed in a timely fashion.

– it’s meant to be about the patient –

Well Yes, and in a broader sense this society is meant to be about people- all of us.
Not just about who will benefit in the short term. And if money is the driver to motivations it will be a short term benefit.
I could go on but I'll stop now...
My thoughts are with you Jackie

Some good resources here too http://www.skylight.org.nz/ Mainly aimed at children, young people and families but not exclusively. Wellington based but some services in other centres.

Hi Jackie, you are right. My wife has recently died after a long dance with cancer. Three months ago things changed and I took leave to care for her. Amongst the teams that came through our house were occasional visits from a counsellor from Hospice, a minister friend, and the main hospice nurse assigned to Denise. Both of us utilised these people through this intense and all-consuming time. For Denise, it was addressing her fears of what she was going through and working out a sense of meaning in the chaos of the body's self destruction, while for me it was keeping a sense of perspective, keeping touch with the outside world, and also preparing for what now lies ahead of me. Some of what we did would have counted as "counselling" and in one conversation much deeper. These professionals were able to offer a safe space to talk without having to cope with others with their anecdotes, sureties, well intentioned but inappropriate advice and so much more. As for the grief I am now experiencing: being aware it is a journey and not a process, helps. The latest stuff out of the APA trying to reclassify grief as a pathological condition is alarming. How does medication help one live in a world without one's beloved.
Thanks Kyle for your useful perspective on the issue. As a member of a profession that has had hundreds of years experience in the talk/listen/counsel model (being a clergyman) I know this approach works – but then being a clergyman, what would I know?

Jackie - this is a hard time, for both of you. Afterwards is hard too, but you will get there. For now, if you can be with your friend as much as you are able, and talk about the good times, and laugh about the funny times and cry about the bad times, that will help. Some.

Arohanui to you, and to Alistair.

" Judith Collins sees no evidence it works and WINZ are also reportedly tightening up the access of funding via disability top ups for counselling costs. "

There's none so blind as those who do not want to see....

Oh Alistair. My heart aches for you, and for your family. This is a very short dance, I fear. Not much time for us all to get our heads around it. May you laugh again, and feel joy. Arohanui.

The first time I went to a counsellor was when I was supporting a family member (my husband) who was terminally ill. I had read the contact details on the noticeboard in the ward numerous times but thought all that usual stuff about my needs not being important, that there are probably more worthy people who need their time etc etc. She did home visits which also causes anxiety for me not having a house like the ones in the magazines. However, was great. All that stuff about there being no rules for the correct way to support someone, and that you are allowed to have a range of emotions, and what's more it is OK to talk about them to the person with the illness. Being honest with each other meant no more tiptoeing around each other, worrying about not upsetting the other person, trying to be strong all the time. Meant the last few months were good quality time. All from one free hospital-provided counselling session.

I also found a good counsellor to go to quite regularly after he died as I found anticpatory grief is not the same as actual grief - but that is another story.

Yes. Anticipatory grief. I had never thought of it that way, but that's what it is. And I am so sorry about your husband, Hilary. I had no idea.

As a member of a profession that has had hundreds of years experience in the talk/listen/counsel model (being a clergyman) I know this approach works – but then being a clergyman, what would I know?

Yes the clergy did have to counsel people and of course it worked. I'm not sure that the hundreds of years experience would count for much tho', as often the clergy had an agenda it was pursuing. But unless you are willing to confront a lot more that you are probably prepared too. Lets just leave it at that.

It was a long time ago – and babies born when he died now have babies of their own. But that thing of there being no rules, no normal way to do grief is so right. It can also take a long time to fade from painful to chronic sorrow, to just memory, but it happens eventually. Good to have lots of safe talking opportunities along the way.

Incidentally, heard a talk by the head of counselling at Vic yesterday in the light of the big earthquake we had and the ongoing smaller ones we keep having. He said that same thing, no normal way to react, and for many, especially those who experienced the Christchurch ones, it could trigger even more severe anxiety. But he said keep talking to each other as that will also help rebalance the logical brain (the buildings have been checked for safety, and there are good systems in place) with the emotional brain (terror). Said make an effort to keep talking to colleagues and seek professional help if needed. Talking is good!

Kyle, we (Sovereign) would have been very happy to talk to you at any stage to help you report the facts around how we approach policyholders who are incapacitated due to mental illness. Unfortunately there were many inaccuracies in the article you have referenced as your source.

The insurance policies under discussion are generically termed ‘income protection’ policies where policyholders will make a claim because they cannot work due to illness. They receive a monthly benefit, depending on their specific policy. Sovereign’s product is called ‘Disability Income Insurance’. Benefits under these types of policies at the moment don’t actually cover treatment cost. However, we may elect to pay for treatment costs to facilitate rehabilitation and this could include mental health payments, if advocated by the treating doctor. Our position on these types of payments has not changed.

Payments for mental health issues are not covered under health insurance products and this is most likely to be the case for most other providers.

In terms of how we may approach a policyholder who cannot work due to mental health issues:
• Sovereign pays for evidenced-based treatment. A rehabilitation programme for a policyholder suffering from mental health may include Cognitive Behavioural Therapy (CBT), an exercise programme, and/or pharmacological treatment. Any rehabilitation programme is developed and managed by the policyholder and their own GP.

• If CBT is prescribed by a medical practitioner as part of a rehabilitation programme, Sovereign pays for the treatment - we will also provide funding for Specialist Assessment as a Psychiatrist has the training and experience to develop treatment programmes for people suffering from mental illness.

• We work closely with our policyholders who suffer from depression to do everything possible to help them back to a life where they can function as they did, pre-claim. For example, we recognise (as do the Mental Health Foundation) that exercise is probably one of the most effective ways for a person to recover from depression and as such, we may pay for occupational therapists to develop an exercise programme designed to introduce not only physical activity into the person's life, but a daily routine. Much of this work and relationship management is not covered under any policy, but we recognise it is much better for everyone for a person to be back at work and living a life with better wellbeing.

David Drillien
General Manager Marketing and Product, Sovereign

For example, we recognise (as do the Mental Health Foundation) that exercise is probably one of the most effective ways for a person to recover from depression and as such, we may pay for occupational therapists to develop an exercise programme designed to introduce not only physical activity into the person’s life, but a daily routine.

Yeah all well and good, but we need to talk to each other. And to people who know the individuals situation intimately. And that takes time. Not something covered in your bottom line(dreadful expression) I bet!

David,
I would certainly happily support any public statement from Sovereign that clearly states that they support and are happy to continue to fund the ongoing use of talk therapy in the treatment of depression, and especially in those covered under your income protection policies.

One point of clarification from your comment. It is not only psychiatrists who are qualified to diagnose and make treatment recommendations for those affected by depression, this is a role that clinical psychologists and registered psychotherapists can also fulfil. This is well recognised by the public mental health system and by the ACC.

Furthermore Cognitive Behavioural Therapy or "CBT" is not the only evidentially supported talk therapy treatment for depression. The UK's NICE guidelines for example rightly recognise that many forms of talk therapy may be beneficial in the treatment of mild to moderate depression.

Long shot; long bow. And might be totally inappropriate. But theres a book called "A Course in Miracles" which might be of use to you (or it might not ) If you are interested, I can get a copy to you without cost (davidknz at clear dot net dot nz). Apologies in advance if I've spoken out of turn ;-)